If you’re like many therapists, you stopped seeing clients in person when the COVID-19 pandemic started. Maybe you were just getting started in practice or maybe you’ve been practicing in person for years. But with the challenges presented by COVID-19, therapists everywhere were faced with taking their practice online or pushing pause on private practice. After months of improvising and doing the best they could with whatever tools they could piece together, many therapists today are making decisions about the most effective way to move forward with their practices during a time when the pandemic is still having a powerful impact on communities.
Whether you’re considering heading back into an office, putting together a hybrid solution, or committing to taking your private practice fully online, we have some tips to help you make the best choices possible that will ensure a positive outcome for you and your clients.
Leverage lessons learned during a year of delivering services online
The pandemic challenged many deeply rooted assumptions—a primary assumption being therapy only works with clients and therapists in-person. Faced with therapy online or no therapy, both therapists and people seeking to continue services or start new ones made a rapid adjustment to meeting together online. Not only did they discover online therapy works, but many people, both therapists and their clients, discovered benefits to working together online. They discovered flexibility. For example, clients often found it easier to fit a session into their schedule when they didn’t have to commute distances to get there. And therapists were able to put drive time to better uses—like fitting in some yoga between clients, and having more family time.
Therapists were quick to notice that many of the young people they were supporting found the technology engaging—they thrived in online therapy in ways they had not in-person. Parents and caregivers became more involved, improving opportunities for carry-over, especially in services such as speech-language pathology, and occupational therapy. Some teens receiving behavioral and mental health support relaxed and opened up more in the electronic environment they were comfortable in.
Then there are the technology lessons learned. It’s easy for therapists to take their internet service provider for granted until internet service suddenly stops working. There’s nothing worse than opening a browser, clicking, and receiving the message, There is no Internet connection((Holslin, Peter (2021). No Internet Connection? How to Troubleshoot Internet Issues. Retrieved from https://www.highspeedinternet.com/resources/no-internet-connection-troubleshooting-guide)). Lesson learned—log on early enough to troubleshoot if you have problems. Make sure your Internet provider has solid technical support—ideally, you want to be able to reach someone on the phone or live chat to help you troubleshoot when necessary. If it happens a lot, it’s probably time to change providers. That could be your opportunity to upgrade your service to high-speed fiber.
And last, with the enormity of the pandemic taking people by surprise, therapists new to the online therapy world typically defaulted to the most familiar, free videoconferencing software, attempting to bend platforms designed for business to their needs. They cut corners on privacy and security requirements and made do. Lesson learned: the best platform for teletherapy is made for that purpose from the ground up.
Create a private, professional, and welcoming online office space in your home
Whether you’re working with an office space that you improvised during the pandemic, or starting from scratch, you’ll need to take as much care setting up your home office as you would with a brick-and-mortar office. It needs to be professional and inviting for both you and your client. Make sure your chair is comfortable and supports good posture. You might want to create a standing option depending on how many clients you see in a day. And make sure you cannot be overheard or interrupted—have a plan in the event that you are interrupted unexpectedly.
Your online office includes the physical space on your side AND the physical space on your client’s side. Coach clients in advance to identify a spot for therapy in their home where they will not be interrupted or overheard (in some cases, this might even need to be their car or a bathroom).
Pay attention to lighting for your online office space. Position your screen and camera facing away toward windows, not behind, if possible. Light from behind can cast shadows. If you have to have a window behind you, close blinds or a curtain. If your office space is dark, consider using a special videoconferencing light and experiment with what works best for soft but well-lit video. Make sure to position your camera for a straight on view of your face. A camera placed too high or too low can be distracting.
Revise your therapist/client agreements to reflect your new format
Create a welcome package easily shared through email. Your goal is to ensure through clear and signed upfront agreements that your clients understand that therapy online is as real as therapy in person and has clear agreements between therapist and client. Include expectations for being on time, how to deal with cancellations, (everything you do in person but updated for the online environment).
Get clear on your pricing model for online services and include that in the welcome packages. Outline how you will accept payment. Will you accept Zelle®, Venmo, or other app payment systems? Hint: don’t give too many options. Keep it simple.
Consider under what circumstances it would not be appropriate to work with someone online so that you have that clear up front and can refer them to someone who can support them.
Privacy and security matter more than ever now
As a provider in private practice, you are probably familiar with HIPAA—the Health Insurance Portability and Accountability Act. Created in 1996, HIPAA is a “federal law that required the creation of national standards to protect sensitive patient health information from being disclosed with the patient’s consent or knowledge.”((“Health Insurance Portability and Accountability Act of 1996 (HIPAA)” Retrieved from https://www.cdc.gov/phlp/publications/topic/hipaa.html)) FERPA—the Federal Educational Rights and Privacy Act—is the federal law that protects the privacy of personally identifiable information (PII) in students’ education records. FERPA protections apply equally to brick and mortar settings and the digital environment.
PresenceLearning’s ebook, Remote Evaluation: A Practical Guide((Taylor, S. & Wright, A. Jordan. (2021). Remote Evaluation: A Practical Guide. Retrieved from http://go.presencelearning.com/ODQ1LU5FVy00NDIAAAF_rZvL3KBdrzbFeWYWwbfqjUHTNeTCVFdjsOEIiI8Is9HfxSixuWR1Wy21YJ-66VQ-8x86TJ4=)) offers these recommendations on privacy and security for teletherapy:
“It’s important to consider HIPAA- and/or FERPA-compliance for a tele-assessment platform. Protection of client data and information should always be a top priority. Especially in the case of psychological assessments, information communicated is private and sensitive (and much of it constitutes protected health information). Not only must you ensure that the platform you are using is HIPAA-compliant during sessions, you need to think about HIPAA- and FERPA-compliance in the storage and retention of materials. When working with schools, they may have specific policies about who retains the original test records and student booklets. If a video has been created, it constitutes an educational record which has specific rules around how/if it can be retained and destroyed. To protect yourself, familiarize yourself with federal, state, and school policies.”
The therapy platform you use affects the outcomes of therapy sessions. Make an informed choice.
Under the pressure of the COVID-19 pandemic when meeting in person became impossible, many therapists rushed to offer online sessions for their clients, all too often defaulting to the most familiar video meeting platforms. In addition to privacy and security compromises, platforms created for business purposes and simple 1:1 family and friends meetings lack the specific tools and resources clinicians need to conduct the most effective therapy sessions.
Platforms designed specifically for therapy should include features such as:
- High fidelity sessions with crisp, clear video and audio
- Built to be HIPAA- and FERPA-compliant
- Dynamic camera and video modes to focus on multiple types of intervention
- Synchronized collaborative workspace
- Curated content library to help you personalize your sessions for each individual
- Ability for clinicians to easily and securely upload their own therapy materials
- Live, online support
The right systems will make smooth running and happier clients
Spending a little time up front researching scheduling platforms can save you a lot of time in the long run. You may already have an online scheduling system set up, but if not, ask your colleagues and peers what they’ve found to be the best platforms. A search on “scheduling platform reviews” will bring up some great overviews of the more popular platforms. You probably already have a billing system set up but shifting to an online practice could present a good opportunity to review if it’s doing everything you need it to do. Again, don’t hesitate to ask peers with online practices about what they like and why.
Moving your practice online also offers an opportunity to revisit and evaluate your note taking strategy and tools. The advantage of online note-taking platforms is that you can write and view your notes on screen. A search on note-taking apps will give you a range of recommendations to review.
Build a marketing strategy to connect with your target audience
Update your website with your new online focus—it might be a good time for a new photo and some testimonials from clients you have been serving during the pandemic. If you’re a writer, consider starting a blog to help you to build your email list. Blog writing doesn’t have to be tedious. Set a schedule that works for you, and find inspiration from reading other blogs—notice which ones catch your attention and what you like about them. If you’re not comfortable writing, consider working with a marketing consultant to produce some posts to boost your SEO.
If you want to skip the blog, you could create a dedicated Instagram account and post occasional stories/videos sharing relevant content to help promote your services.
A marketing consultant can help you seek out webinar opportunities to grow your community. Think about what topics you’d like to share with people, work on an outline for a simple presentation, and create some slides using Powerpoint, or Google Docs. Share that with people you’d like to collaborate with on a webinar. If you’re comfortable interviewing, think about a few people you’d like to interview to talk about topics that would be of benefit to your clients.
Appreciate the benefits of an online practice
It’s been a rough time since COVID-19 swept in to change our world. Clients need us more than ever. Making the necessary changes to continue serving the people you care about, in addition to dealing with your own pandemic stress and losses, is challenging. But once you begin to feel comfortable with your new online practice, you’ll find many new benefits to appreciate. Take time to acknowledge them.
First, you can put the time you previously spent commuting into whatever you choose. Maybe it’s time to start that exercise routine you’ve been imagining with the commute time you’ve gained back. Remember frustrating last minute cancellations that had you stuck in your brick and mortar office waiting for the next client to arrive? Now, you can take a much-needed walk, check on a child doing homework, get a meal started, or just relax at home and have a cup of tea. And income previously spent on office rent can be invested in a great platform, support systems, marketing, virtual assistants, professional development, health and well-being.
A platform designed by clinicians for clinicians—for individual and group therapy
“The PresenceLearning platform has given me the flexibility to expand my own practice. Now, I am able to see more clients, and create a schedule that works for my busy life.”–Gazit Nkosi, SLP
The award-winning PresenceLearning platform was created by clinicians, specifically for teletherapy, and includes measures to ensure client security and confidentiality. The Therapy Essentials product supports clinicians in private practice to deliver online speech therapy, occupational therapy, behavioral and mental health therapy, assessment, and more.
Features of the Therapy Essentials platform include:
- Dedicated therapy room URL
- Tools and content to customize and personalize therapy
- Personal library—you can upload your own materials
- Multiple camera and video modes
- Interactive whiteboard
- Shared browsing and screen sharing
- Live, secure in-platform support
- Online Help Center
- Assessments from major publishers (with Therapy Essentials Plus package)
